Headache sufferers have hope. While the pain drives most to attempt various remedies, new understanding, science and technology provide simple tools to help you manage.
This 5 minute video is a fantastic shortcut to understanding 1 common headache, Migraine. It is also helpful for understanding other types of headache.
To expand on this fantastic video, I've provided some useful links throughout this blog.
First and foremost, there are many types of headache. It is important to receive the correct diagnosis which may not alway be straightforward. While clinicians and researchers use the International Headache Society Guidelines to diagnose your type of headache, it's important to understand your role in the diagnosis.
Some factors, such as genetics (your parents) and some environment may not be 100% under your control to change; therefore, it's important to have a grasp of those factors which you can change. As Dr. Cowan, MD points out in the video, these factors require observation and planning.
A headache diary is probably the most useful tool in helping you take control of your headaches. It's also cheap, costing you little to no money, and cost-saving because you won't have to aimlessly run around to different specialists. If you do see a specialist, it's likely they will ask you to record your headaches for 1 to 3 months anyway. So get started today. You can even use an amazing, free app. Or, noting down in a paper diary things like frequency (date), duration (total time), intensity (rate from 0-10) and associated factors (food/drink triggers, skipped meals, hormonal changes, quality of sleep, stress levels and exercise). This tool is cheap, effective, personalised and tells you and your doctors very helpful information to 1) Diagnose the type of headache accurately and 2) Empower you to make educated decisions on planning and management strategies.
There are over 150 different types of headache, and they are not all managed the same. This is why a correct diagnosis is so important. For the purpose of this article, The international headache society classifies headaches into 4 primary types: Migraine, Tension-type headache, trigeminal autonomic cephalalgias, and other. (Secondary Headaches from traumatic injury, and neuropathic headaches make up seperate categories in the IHS Guidelines).
Appropriate diagnosis underway, how do you then manage the condition? A 3 pronged approach includes acute care, prevention and lifestyle modification.
Rescue or Acute care generally involves understanding the condition and management with medication, as well as creating a "safe environment" such as a dark, quiet room for migraine sufferers.
Prevention includes an understanding of the triggers which may bring about a headache, and then you can choose to participate in them or not. The example in the video is excellent. Red Wine and Poor sleep are sometimes stressful triggers for some primary migraine sufferers. Therefore, if you are genetically wired to be prone to migraines, and know that you have not had a restful night's sleep, you can choose a different type of beverage that evening to limit the likelihood that you will experience a migrane. Or, you can choose the red wine, and risk having a migraine. You still have control, however, you at least have an understanding about the trigger and can take appropriate action for the following day (such as preparing a dark, safe room during the headache, or taking certain types of medication).
Lifestyle modification is essential but difficult. Environmental factors, such as stress, can be managed to some extent with exercise, meditation and diet. But these may be difficult for some people to maintain. Getting support from a local group is an option. Ask your GP, or we are happy to inquire with some local groups on your behalf. It's usually better to get help rather than trying to make change on your own.
Some headache sufferers carry tension or stress in muscles and joints around the shoulder, neck and skull. These headaches may be "cervicogenic" in origen. Here, postural advice and ergonomic advice are useful, as are exercises that reduce the load on this musculature. For years, chiropractors have developed a reputation for relieving headaches with soft tissue massage, joint mobilisation and spinal manipulative therapy. Recent high quality evidence suggests 6 to 8 treatments of spinal manipulation is superior to mobilisation and exercise alone, and cervicogenic headaches diminished drastically in those who underwent spinal manipulation. This treatment may also remove some of the triggers associated with migraine sufferers, and be an effective management strategy, however, sometimes migraines have other stressors, such as hormonal changes or diet. Again, speaking to the right clinician is essential.
While Spinal Manipulation Therapy is safe, safe, safe, it is important that you see an appropriately trained manual therapist for the procedure, as some patients may have a pre-existing vascular condition. Afterall, there are risks inherent in any intervention including some common over-the-counter NSAID medications. Some headaches may be a sign of more sinister underlying cause. Young females who use the Oral Contraceptive Pill are at a slightly higher risk of Cervical Artery Dissection, and some patients who present to a clinician with a new headache of sudden, severe onset may be experiencing a stroke. In these circumstances, manual therapy is inappropriate and referral to ER or a Neurologist is necessary. These very rare events can be detected by a thorough history, as well as a clinical exam inclusive of a cranial nerve screening exam. The most recent systematic review found no evidence for causation of stroke with spinal manipulation; however, an association may be present. This association is most likely due to patient presenting to a clinician with a stroke in evolution, and the cause is not correctly identified by the medical practitioner, chiropractor or physiotherapist. As such, a cautious approach is warranted; however, spinal manipulation by a trained clinician who has ruled out other conditions, can apply the procedure in a safe, effective and affordable way. Anyone who says there is no risk is not telling you the whole story; and anyone who says it is risky is uninformed or prone to bias. For some patients, it is the right procedure provided they are fully informed, education and relaxed.